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 Researchers focused on the effectiveness of Housing First, a program
in Toronto that's different from traditional approaches to housing
for homeless adults with mental illness that require aid recipients
to achieve sobriety and or undergo psychiatric treatment. Housing
First provides immediate access to housing and mental health
services without any preconditions.
All 575 participants in the current study were homeless and mentally
ill, and some of them also had substance use disorders. Researchers
randomly assigned them to receive Housing First services with
community treatment or with intensive case management, or to a
control group that only received access to more traditional support
programs.
Over the first year of the study, people assisted by Housing First
spent 70% to 72% of their days in stable housing, whereas people who
received traditional support services conditioned on sobriety and
psychiatric treatment spent 23% to 30% of their days in stable
housing, the study found.
And by the sixth year of the study, people assisted by Housing First
spent 86% to 88% of their days in stable housing, compared with 60%
to 78% of days in stable housing for individuals who received
traditional support services.
Much of this difference might be due to the higher likelihood of
unmet needs among homeless adults who received traditional support
services instead of immediate assistance through Housing First, lead
study author Dr. Vicky Stergiopoulos of the Center for Addiction and
Mental Health in Toronto and colleagues write in Lancet Psychiatry.
"Participants with high support needs in the TAU group maintained
persistent low levels of housing stability during the study period,
exposing persisting access barriers to appropriate services for this
population," Stergiopoulos and colleagues write.
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"These findings highlight the unmet needs of homeless adults with
mental illness and high support needs, even within a resource rich
service delivery context, and the limited effectiveness of usual
services in supporting housing stability for this population," the
authors write.
The study is the first to suggest that Housing First is associated
with lasting increases in the number of days homeless adults spend
in stable housing, especially for individuals with more severe
mental health needs, the study team notes.
Housing First wasn't associated with improvements in quality of
life, reductions in the severity of substance abuse problems, or
better functioning in the community, the study found. But the
program didn't make any of these outcomes worse, either.
It's also not yet clear what specific aspects of Housing First might
have had the most positive impact on the lives of homeless adults,
or how easily a program like this might be replicated.
Even so, the results add to the evidence suggesting that the Housing
First program does meet the needs of many adults it serves, Emmy
Tiderington of the Rutgers School of Social Work in New Brunswick,
New Jersey, writes in an editorial accompanying the study.
"This study adds to an extensive body of literature that has already
demonstrated the positive effect of Housing First on housing
stability over time," Tiderington writes. "The major contribution of
this particular study is the documentation of the effect of the
intervention over a 6 year period, which is the longest follow-up to
date."
SOURCE: http://bit.ly/2XKvj5o Lancet Psychiatry, online October 7,
2019.
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